Sanitary Statistics Research Articles

Trends in Stage-Specific Kidney Cancer Incidence in Kazakhstan, 2005-2019.

The aim is to analyze the incidence of kidney cancer over a 15-year period, considering factors such as stage, age, sex, and morphological verification in the regional context in Kazakhstan. The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. Among the meticulously documented 15,277 cases, a conspicuous male predominance was noted, comprising 53.7% of cases compared to 46.3% in females, with peak incidences observed within the 50-69 age cohorts. The average age at diagnosis exhibited a progressive rise over the study period, with discernible variations observed in age-specific incidence rates, particularly pronounced within the 60-84 age brackets. Noteworthy temporal trends indicated a consistent uptick in crude incidence rates, with distinct regional disparities manifesting higher rates in northern regions relative to their southern and western counterparts. Stratification by cancer stage unveiled a significant surge in stages I-II cases alongside a concomitant decrement in stage III incidences, complemented by reductions in stage IV occurrences and instances of unspecified disease stages. Morphological verification rates displayed regional variations, with an overarching ascending trajectory across most regions, albeit exceptions noted, notably in the Kyzylorda region. Our study identified a rise in kidney cancer incidence in Kazakhstan, likely reflecting global trends driven by increased risk factor exposure and incidental imaging findings. Regional disparities and varied stage distributions highlight the complexity of kidney cancer epidemiology. Despite advancements in early detection, delayed diagnosis persists, necessitating improved surveillance and diagnostic practices.

Liver Cancer Incidence in Kazakhstan: Fifteen-Year Retrospective Study.

The aim is to study the trends of liver cancer (LC) incidence in the regional context in Kazakhstan. The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. Between 2005 and 2019, 13,510 cases of LC were documented, comprising 59.3% males and 40.7% females. Most diagnoses were seen in age groups 55-59 years (13.3%) to 75-79 years (11.7%). LC patients' average age increased from 63.6 to 64.5 years. Incidence rates per 100,000 peaked at ages 65-69 years (35.1±1.0) and 70-74 years (43.3±1.0). LC incidence notably rose in the 70-74 years age group (APC=+0.89), contrasting with declining trends in younger age groups. Regional incidence variations revealed diverse patterns, mostly demonstrating unimodal increases, and some regions displaying bimodal growth. The age-standardized incidence rate was 5.7±0.1 per 100,000, declining from 2005 to 2012 (APC: -3.93), then rising until 2019 (APC: +1.13). Gender-specific standardized rates showed varied trends. Analyses of standardized indicators indicated declining trends in most regions but increased values in specific areas. Thematic maps classified incidence rates based on standardized indicators: low (up to 5.22), average (5.22 to 7.11), high (above 7.11 per 100,000 for the entire population). The study on liver cancer in Kazakhstan reveals marked gender and age differences. The standardized incidence rate among men was twofold greater than that among women. A distinct rise in cases was noted among individuals aged 70-74 years. Regional variations in incidence were evident. These findings emphasize the necessity for focused research to comprehend the causes behind these differences, enabling customized interventions for Kazakhstan's population.

The venereal morbidity in Russia in 1914-1924

It is accepted to explain increasing of venereal diseases during years of the Revolution by degradation of morality and general disorder of system of state administration and sanitary services in Russia. The cross-verification of information presented in scientific publications and primary information sources makes it possible to look into following issues: degree of venereal (syphilitic) contamination of population of pre-revolutionary Russia; influence on sanitary statistics by erroneous diagnostics and convictions of Zemstvo medicine about predominantly non-sexual path of transmission of syphilis pathogen in Russian countryside; dynamics and sources of venereal morbidity in wartime. The high indicators of pre-revolutionary statistics of venereal infections could be affected by diagnostic errors. The "village syphilis" encountered in public milieu could be completely different disease not sexually transmitted and not chronic form of disease. The primary documents allow to discuss increasing of the number of venereal patients during war years, that however, does not reach catastrophic numbers that can be found even in scientific publications. This is also confirmed by data of Chief Military Sanitary Board of the Red Army for 1920s and statistical materials of People's Commissariat of Health Care of the RSFSR. The high morbidity was demonstrated by same Gubernias that were problematic before the Revolution and only later by those ones through which during the war years passed army masses. In Russia, total level of syphilis morbidity after the end of Civil War occurred to be more than twice lower than in pre-war 1913 and continued to decrease under impact of sanitary measures of Soviet public health.

Health statistics indicators as a factor in accounting for occupational morbidity

Introduction When analyzing the risk of the impact of harmful factors on the health of employees, some researchers explain the low incidence of occupational diseases in Russia by errors in their detection during preventive examinations, lack of interest of employers and employees in the detection and registration of these diseases, and other reasons. At the same time, we did not find any works in the literature devoted to errors in coding of diagnoses of occupational diseases and their registration.The purpose of the work is to identify the cause of poor accounting of occupational diseases in Russia.Materials and methods The work was carried out on the basis of the Industrial Register of persons with occupational diseases. The registry was developed by the A.I. Burnazyan Federal Medical and Biological Center and has been in commercial operation since 2011. As of 31.12.2020, the register contains information about 2 300 patients with occupational diseases from among the employees of enterprises and organizations served by the health care institutions of FMBA of Russia. Directive documents on identification and registration of occupational diseases were analyzed.Results and discussion Analysis of the health of the working contingent and the subsequent creation of plans for medical and rehabilitation measures to reduce the incidence of occupational diseases among persons working at enterprises and organizations that are on dispensary registration in health care institutions of FMBA of Russia, requires knowledge of correct morbidity indicators about them. For this purpose, it is necessary to improve the registration of occupational diseases in Russia by switching to the diagnosis coding system adopted in the country’s sanitary statistics, and to make appropriate changes in policy documents.Conclusion One of the reasons for errors in recording occupational diseases is the violation of classification principles in the Order of the Ministry of Health and Social Development of Russia No 417n.

Epidemiology of Breast Cancer Mortality in Kazakhstan, trends and Geographic Distribution.

According to the International Agency for Research on Cancer, ongoing demographic changes will lead to an increase in the number of deaths from breast cancer (BC) per year in the vast majority of regions. In 2040 it is expected that 1.04 million people worldwide will die from this malignancy, including 2,380 women in Kazakhstan. The retrospective study (2009-2018) was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. During 10 years 12,958 women died from BC. An average age of the death was 61.6 years (95%CI=60.6-62.6) and tended to increase (APC=+0.6%, R2=0.6117). Age-specific rates had a bimodal increase with peak rates at 70-74 years - 76.7±5.5 (APC=+3.4%, R2=0.2656) and 80-84 years - 78.0±9.1 (APC=+3.7%, R2=0.0875). The age-standardized rate was 13.9 per 100,000 of female population, and the trend has decreased. When compiling thematic maps, mortality rates were determined on the basis of standardized indicators: low - up to 12.5, average - from 12.5 to 15.2, high - above 15.2 per 100,000. The results of the spatial analysis showed the regions with a higher levels of BC mortality rate per 100,000: Pavlodar (16.9), Almaty (19.2) and Astana cities (19.3). Age-standardized mortality rates had a strong downward trend (APC=-4.0%, R2=0.9218). The decrease mostly is due to a large coverage of the population by mammography screening and to an improvement in the effectiveness of breast cancer treatment.

Epidemiology of Lung Cancer in Kazakhstan: Trends and Geographic Distribution.

The aim is to study the trends of lung cancer (LC) incidence in the regional context in Kazakhstan. The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific incidence rates are determined according to the generally accepted methodology used in sanitary statistics. The data were used to calculate the average percentage change (APС) using the Joinpoint regression analysis to determine the trend over the study period. Over the 10 years under study, 36,916 new cases of LC were registered in the country (80.5% - in men and 19.5% - in women). During the studied years the average age of patients was 64.2±0.1 years (95%CI=63.9-64.4). The highest incidence rates per 100,000 in the entire population were found in the age groups 65-69 years (147.6±2.7), 70-74 years (159.3±2.5), and 75-79 years (147.1±3.2). The incidence of LC tended to increase only at the age of 80-84 years (APC=+1.26) and the most pronounced average annual decline rates were observed in the age groups of 45-49 years (APC=-4.09), 50-54 years (APC=-4.20) and 85+ years (APC=-4.07). The average annual standardized incidence rate was 22.2 per 100,000, and in dynamics tended to decrease (APC=-2.04). There is a decrease in incidence in almost all regions, with the exception of the Mangystau region (APC=+1.65). During the compilation of cartograms, incidence rates were determined on the basis of standardized indicators: low - up to 20.6, average - from 20.6 to 25.6, high - above 25.6 per 100,000 for the entire population. The incidence of lung cancer in Kazakhstan is decreasing. The incidence among the male population is six times higher than among the female, while the rate of decline is more pronounced. The incidence tends to decrease in almost all regions. High rates were found in the northern and eastern regions.

MEDICAL EFFICACY OF A SPONTANEOUS MEDICO-SOCIAL EXPERIMENT (BY THE EXAMPLE OF COVID-19 REGIONAL PREVENTION)

Relevance: studies of the effectiveness of large-scale medico-social experiments (MSE) are quite rare. On the one hand, MSE is, as a rule, a response to force majeure circumstances, which should not be at all in ordinary live. On the other hand, such experiments, as well as their study, are processes characterized by high cost and considerable duration. Nevertheless, the example of COVID-19 regional prevention shows that coordinated interaction of various parts of the social organism can and should be carried out in a critical situation, that the effectiveness of this interaction should be quantified using integrative indicators of sanitary statistics. This interaction illustrates the spontaneous formation of a regional model of preventive healthcare of the future, which is characterized by active socio-economic and information-cognitive support of the main preventive and (or) treatment and diagnostic process aimed at the population of the region using a wide range of activities, including traditional and new educational technologies.
 Gol: to evaluate the medical effectiveness of the first pre-vaccination year of COVID-19 prevention at the regional level using integrative quantitative indicators of sanitary statistics.
 Methods: historical, statistical, graphical, linear regression analysis, system analysis and synthesis, organizational and methodological modeling.
 Results: the slope coefficients in the linear regression formulas corresponding to the annual growth rate (GR) on the graphs of prevalence and incidence in the studied social groups indicated that in the pre-pandemic years, the prevalence in the population was permanently growing - GR was within from +17 to +49 ‰ per year, and the incidence showed relative stability - GR was in the range from +8 to +12 ‰, and even decreased in the children’s population (-17 ‰ annually). Comprehensive preventive measures of the first pandemic year (2020) reversed the general growth trend and accelerated the process significantly. Thus, incidence GR was in the range from -35 to -257 ‰, and prevalence GR - from -179 to -326 ‰.
 Conclusion: preventive measures against COVID-19, carried out in the form of a large-scale MSE, made it possible to introduce at the regional level a model of systemic integrated preventive healthcare of the future, the medical effectiveness of which is many times greater than the previous organizational and methodological model of “autonomous” healthcare, as far as this can be judged by the emerging trends of change integrative indicators of health (prevalence and incidence).

Colorectal Cancer Mortality in Kazakhstan: Spatio-Temporal Epidemiological Assessment.

Objective:The aim is to study the trends in colorectal cancer (CRC) mortality in Kazakhstan. Methods:The retrospective study was done using descriptive and analytical methods of oncoepidemiology. The extensive, crude and age-specific mortality rates are determined according to the generally accepted methodology used in sanitary statistics. Results:CRC mortality in Kazakhstan is considered to be increasing. Therefore, this study (for the period 2009-2018) was undertaken to retrospectively evaluate data across the country available from the central registration bureau. Age standardized data for mortality was generated and compared across age groups. It was determined that during the studied period 15,200 died of this pathology. During the studied years an average age of the dead made 69.8 years (95%CI=69.5-70.0). The average annual standardized mortality rate was 10.2 per 100,000, and in dynamics tended to decrease. Peak of mortality was noted in aged 60-84 years. Trends in age-related mortality rates had a pronounced tendency to increase in 30-34 years (T=+11.7%, R2=0.7980) and to decrease in 75-79 years (T=–16.4%, R2=0.8881). In many regions, there is a decrease in the number of deaths. During the compilation of cartograms, mortality rates were determined on the basis of standardized indicators: low – up to 8.9, average – from 8.9 to 11.5, high – above 11.5 per 100,000 for the entire population. In addition, all calculations were made taking into account age-sex differences.Conclusion:Trends in mortality from CRC in recent years have decreased from 11.2 to 7.7 per 100,000 of the total population, while the trend is stable (T=−3.6%, R2=0.8745). The study of regional mortality has theoretical and practical significance: monitoring and evaluation of the effectiveness of early detection and treatment of detected pathology. Health authorities should take into account the results obtained when organizing anti-cancer measures.

Epidemic and sanitary charts and tables of the second half of the XIX century as the “health passports” for Russian territories

The title of this article reproduces the intentions of the creators of the health cards and the hopes of their modern viewers. Judging by the statements, they wanted to see and show the state of the sanitary and epidemiological situation in the Russian Empire and wanted to do it as reliably and clearly as possible. The article’s authors asked themselves a question: have these desires and hopes come true, that is - are now the tables of sanitary statistics and disease maps “health passports” of various administrative and territorial units of the Russian Empire? Can historians use them as reliable evidence? In order to answer this question, it was necessary to reconstruct then existing system for recording and collecting data on infectious patients, diseases and pathogenicity, ways of their aggregation and representation. Only then would it be possible to find out how these data were applied to conditional terrain images, why either manufactured terrain plans or an administrative map of the empire were used, what was visible and what was in the dark zone. The article’s authors found that the resources available in post-reform Russia did not make it possible to make the collection of sanitary statistics total for the entire territory timely, and even more so to organise a retest of practical information. The supply of information depended on the density of the network of medical institutions in the empire and doctors’ ideas about the value of such information. This circumstance ensured fragmented, multi-temporal and spatial asymmetry in showing the sanitary condition of the Russian Empire and the morbidity of its inhabitants. On this basis, medical historians are advised to read these mediums in the reverse perspective: high morbidity rates should be read as evidence of well-organised medical care (i.e. relative epidemic well-being) and vice versa.

The contribution of medical community into elaboration of theoretical problems of health care in the sixties of XIX century

The article considers activity of medical societies in 1860s related to theoretical development of problems of organization of Zemstvo medicine, sanitary statistics, medical topographical studies, preventive course of public medicine. It is demonstrated that results of these activities hereinafter were widely applied in the course of health care reforms of the second half of XIX century.

ORIGINS OF FORMATION OF KYIV SOCIAL AND HYGIENIC SCIENTIFIC SCHOOL: FROM THE FUNDAMENTALS OF MEDICAL SCIENCE, MEDICAL POLICE AND SANITARY STATISTICS TO SOCIAL MEDICINE AND PUBLIC HEALTH

The aim of the work is to study the stages of formation of the Kyiv social and hygienic scientific school, the contribution of its founders to the development of medical and social scientific direction.
 Materials and methods. The source base consisted of published scientific papers and archive materials. The historical-bibliographic method has been used in this work.
 Results. The formation and development of the Kyiv social and hygienic school has deep historical roots, beginning with the scientific achievements of many generations of researchers, which were generalized and transformed into the discipline of "state medicine" and began to be taught at the department of state medicine at St. Vladimir's University in Kyiv, and later – at the department of hygiene, medical police, medical geography and statistics. Teaching of medical and social issues continued for a long time at multidisciplinary departments. Prominent hygienists contributed to the formation of the socio-hygienic scientific direction, including professors Subbotin V.A. and Orlov V.D., who highly appreciated the importance of statistics, epidemiology and organization of health work, contributed to their teaching within the training programs for future doctors. A decisive role in the formation of the Kyiv social and hygienic scientific School was played by Professor Korchak-Chepurkivsky O.V., who is considered to be its founder. The course on epidemiology and sanitary statistics developed by him in 1903 and the course "Fundamentals of Social Hygiene and Public Medicine" in 1906 laid a solid foundation for the progressive development of social and hygienic science in Ukraine, helped to establish its theoretical principles, substantiate its content, and improve methodology. Consistent advocacy by scientists of scientifically sound results of socio-hygienic research has often led to his persecution and harassment by the authorities. Insistence of Korchak-Chepurkivsky O.V. on the differentiation of the social and hygienic direction and the creation of a separate department, the mandatory teaching of social hygiene in higher medical education has been crucial for further establishment of departments of social medicine, training of scientific personnel and health professionals.
 Conclusion. The path of formation of the Kyiv social and hygienic scientific school, which was long, difficult and sometimes tragic, constitutes evidence of the progressive development of social hygiene in Ukraine, highlights the trajectory of the medical and social direction, the role of prominent personalities, especially Korchak-Chepurkivsky O.V. in the formation of conceptual principles and content of social hygiene, training of scientific and pedagogical staff, who continued the work that he started.

Establishment of medical institutions in ferghana during the years of soviet power

The deterioration of the world's ecology, global warming, climate change, pandemic conditions require strong attention to health work. The World Health Organization is consistently implementing measures aimed at protecting the health of the population in various regions of the Earth, preventing epidemics, a wave of pandemics, developing and implementing a health program with governments, improving and protecting the health of the environment, protecting the health of mothers and children, training medical personnel, maintaining sanitary statistics, in particular, coordinating scientific and research work. This article is about the establishment of medical institutions in Fergana in the years of Soviet power.

The finances and statistics in materials of the G. E. Rhein Commission

The article analyses financial and statistical aspects of materials from the Interdepartmental Commission for the Revision of Medical Legislation (the G. E. Rhein Commission). The brief analysis of structure, composition and mechanisms of functioning of the Commission is presented. The specificity of the Commission materials is discussed. The information sources are established which were used as background for statistical calculations of the Commission. The calculations themselves are briefly discussed. The particular attention is paid to methods of calculating financial losses in the Russian Empire due to diseases. The study focuses on state health statistics projects and on the financial foundations of the new health care system as well as on their perception by the participants of the Pirogov Society. The data obtained by the Commission was used for devising plans for optimization and centralization of health care, according to which sanitary statistics were to be subordinated to the state. However, financial support to local self-government bodies for sanitary needs was mentioned. Although the physicians from the Pirogov Society had critical attitude to most ideas of the Commission, in the matter of financing they were not only agreed upon with main proposals of the Commission but were also ready to go even further.

362 Walt Whitman, John Mahay, and Urotrauma in the American Civil War

Walt Whitman (1819-1892) was a visionary American poet who inspired innovation within the literary landscape, choosing to preserve real, complex life with poetic imagery. He also chose to volunteer as a nurse during the American Civil War, daring to confront the violent, painful reality of war’s aftermath with precision and unflinching honesty. Volunteer nursing for the Union Army was organized by the United States Sanitary Commission during the Civil War (1861-1865). Our objective is to investigate the urologic management and perspectives of Walt Whitman during his service as a Nurse during the American Civil War. We conducted a review of the literature pertaining to Walt Whitman, his clinical practice, and his relationship to John Mahay during the Civil War. A review of textbooks, peer-reviewed articles, works of prose, and government archives was performed. Original publications and anatomic diagrams were reviewed through the Walt Whitman Archive and the National Museum of Health and Medicine.

When Service Is Not Enough: Charity's Purpose in the Immediate Aftermath of the Civil War

This essay argues that antebellum notions of charity persisted during the Civil War and its immediate aftermath. Sympathy, rather than an obligation owed those who had served their nation in good stead, remained the criterion on which relief workers judged petitioners. To make the case, the essay considers how the largest wartime private relief agency, the United States Sanitary Commission, provided aid to soldiers who made the wartime transition to veteran status due to injury or illness and those veterans who were mustered out of service in 1865-1866. Equally important, it surveys intellectual and cultural currents that informed the war generation's understanding of charity. Sympathy, it demonstrates, demanded affinity, a shared sense of feeling, an appeal to the heart rather than to reason, but it did not demand inclusivity.

COLLECTION AND ANALYSIS OF STATISTICAL DATA ON DEATH AND BIRTH cases AT THE END OF XIX - BEGINNING OF XX CENTURY IN PERM PROVINCE

Aim. To determine the basic changes in analysis of statistical data on the cases of death and birth at the boundary of XIX - XX centuries and at the beginning of XXI century. Materials and methods. Analytical approaches used for studying the population number, birth and death rates at the end of XIX - beginning of XX centuries, compared with modern methods of analysis of the mentioned demographic processes, were estimated. Results. It was revealed that for analysis of demographic data at the boundary of centuries, climatic conditions were the prevailing factors in estimation of birth and death rates. When calculating the population number, religion was taken into consideration. Conclusions. In sanitary statistics, mortality was not analyzed depending on the causes of death; some categories of the population of the Russia Empire were not taken into account, so demographic picture of the region was not reflected in full measure.

So Conceived and So Dedicated: Intellectual Life in the Civil War–Era North ed. by Lorien Foote and Kanisorn Wongsrichanalai

Reviewed by: So Conceived and So Dedicated: Intellectual Life in the Civil War–Era North ed. by Lorien Foote and Kanisorn Wongsrichanalai J. Matthew Gallman (bio) So Conceived and So Dedicated: Intellectual Life in the Civil War–Era North. Edited by Lorien Foote and Kanisorn Wongsrichanalai. (New York: Fordham University Press, 2015. Pp. 307 Cloth, $105.00; paper $45.00.) This volume contains eleven essays about Civil War–era intellectuals. Any study of intellectual life invites questions about definitions. Lorien Foote offers a useful starting point. These essays are about “educated [End Page 137] people for whom ideas mattered” (2). Foote and her fellow coeditor, Kanisorn Wongsrichanalai, have assembled a superb volume in which the pieces fit together wonderfully. Joan Waugh’s short, charming, and absolutely essential foreword sets the stage. Waugh establishes the centrality of George Fredrickson’s magisterial The Inner Civil War: Northern Intellectuals and the Crisis of the Union (1965) in framing any conversation about the intellectual history of the Civil War, while discussing her own “heavily marked” copy of Fredrickson’s slim volume. Waugh reminds us that Fredrickson the brilliant scholar was also a charming fellow who had no trouble with young scholars who—like Waugh herself—“differed and departed from” the narrative set forth in The Inner Civil War. Nearly every essay in So Conceived and So Dedicated mentions Fredrickson, but none of the authors is intent on merely filling lacunae in the foundational text, and none are set on tearing it down—which, one imagines, is precisely how Fredrickson would have had it. Lorien Foote leads off with a historiographical review of the state of the field, with comments on the other ten essays placed within that larger analysis. This wonderful essay deserves attention on its own, as well as for being an introduction to what is to come. Foote considers three crucial questions that have framed the scholarship since the publication of The Inner Civil War: Did the Civil War shift intellectual thought toward modernization? Did it lead intellectuals to embrace “authoritarian modes of thought” (8)? How did the Civil War shape notions of nationalism? Foote’s essay and notes reward careful reading. The questions, methods, and voice employed in the other ten essays are diverse, but the pieces join together in multiple conversations. The authors interact with one another implicitly, and on multiple occasions they explicitly engage with other essays in the volume. The mix of senior scholars and more junior authors is excellent. Together they map out some of the ways scholars are rethinking intellectual history in the Civil War era. Kathryn Shively Meier considers the medical professionals who became involved in the United States Sanitary Commission, while—in a marvelously complementary piece—Susan-Mary Grant looks at the thoughts and experiences of those surgeons who actually worked for the military. In an interesting counter to some familiar narratives, Julie Mujic asks how professors in midwestern universities responded to the particular challenges they faced when their pupils clamored to go to war. Kanisorn Wongsrichanalai flips that tale by considering how antebellum and wartime experiences shaped the postwar activities of three prominent soldiers-turned-educators. [End Page 138] Other authors adopt comparable forms of collective biography, contemplating selected members of key groups. Christian G. Samito examines two Irish Catholics who became prominent prowar Republicans, while William Kurtz finds generally conservative impulses in the writings of a cohort of Catholic editors and archbishops. David Zimring complicates our understanding of the relationship between geography and identity by examining northerners who moved south and largely embraced the politics of their adopted home. Two essays focus on a single figure. Richard F. Miller uncovers the crusade of one New England lawyer to produce empirically sound, fundamentally nonpartisan historical writing about the war; Niki Lefebvre broadens the interpretive lens with a close reading of one artist’s representation of an African American soldier in Harper’s Weekly. Finally, Richard Newman’s intellectually challenging contribution looks at metaphorical discourse surrounding the health of the body politic to reconsider thoughts on the meaning of race and emancipation both during and after the war. These essays should produce scores of “heavily marked” copies for decades to come. Consider just two...

This Birth Place of Souls: The Civil War Nursing Diary of Harriet Eaton (review)

Reviewed by: This Birth Place of Souls: The Civil War Nursing Diary of Harriet Eaton Margaret Humphreys (bio) This Birth Place of Souls: The Civil War Nursing Diary of Harriet Eaton. Edited by Jane E. Schultz. (New York: Oxford University Press, 2011. Pp. 350. Cloth, $74.00.) In her prior work on female health workers in the Civil War, Jane Schultz has set a standard for understanding the role of women in that vast conflict. Women at the Front: Hospital Workers in Civil War America (2007) greatly expanded our knowledge of these women, revealing their varied purposes, functions, and aspirations. In this volume Schultz extends this focus, taking up the story of Harriet Eaton, a war relief worker from Maine who left us a wonderful, detailed diary. While Schultz's first book might be briefly referred to as a "history of nurses in the war," Schultz herself was careful not to put the word "nurse" in her title. The role of "nurse" with all of its modern connotations did not exist in the 1860s, and instead women in hospitals acted in ways that extended their usual behaviors in the domestic sphere. Yes, they gave medicine, fed the bed-bound, helped the surgeon change dressings, and assisted in keeping the patient clean. But women hospital workers also cooked, did laundry, supervised convalescent soldiers who were detailed as nurses, distributed items of clothing, saw to housekeeping tasks, and comforted the men with reading, music, and writing letters home. In southern hospitals much of this work was done by slaves or freedwomen, further confusing the issue. Defining who a nurse was and what a nurse did in any given hospital is a complex task for the historian, and when Schultz calls her manuscript source for This Birth Place of Souls a "nursing diary" in the subtitle, she is somewhat overriding the very complexity that her own work has demonstrated. Eaton herself proclaimed that "the work in which we were engaged differed materially from that of a nurse in the Army" (226). Most Union relief workers generally served under the auspices of the United States Sanitary Commission and the Christian Commission. While the work of women within the USSC has been well explored by historians Judith Giesberg and Jeannie Attie, state relief workers have remained largely invisible. Thus Schultz's volume on Eaton writes a new chapter on women in the war. In the fall of 1862 the Maine Camp Hospital Association hired Eaton, a forty-four-year-old widow from Portland, to help distribute relief supplies to the men in Maine regiments who were deployed in Virginia and Maryland. After Antietam word came back home of wounded and ill men suffering from inadequate food, clothing, and bedding; the society gathered supplies and sent Eaton and a colleague to northern Virginia to help. In her first seven-month tour Eaton traveled from regiment to regiment, [End Page 104] visited their field hospitals, and passed out supplies and facilitated communication with families back in Maine by writing letters for the men, or sending sad missives telling parents of their son's demise. Such "roving nurses" were unusual, as Schultz emphasizes. After recovering from an illness, Eaton was back at war work in 1864, this time in the receiving hospitals at City Point, Virginia. By this point in the war the Union medical corps had become much more efficient at moving wounded and sick men from the battlefield and camp, and there was less need for aid workers in the field. Instead these volunteers were limited to transportation hubs such as City Point, which served as a gathering point for the transfer of incapacitated Union soldiers to the hospitals of the North. Eaton's diary and letters provide ample fodder for historians interested in a variety of topics. Details on the foods distributed provide insight into the nutrition supplied for the ill soldier. Eaton made gruel out of canned chicken; distributed lemons, oranges, and apples; made drinks from condensed milk; lamented an unusual absence of sugar; and otherwise revealed the bounty and variety of foods available to the Union troops. Eaton, like other female hospital workers elsewhere, challenged the behavior of doctors who she felt maltreated...

“We Cubans Are Obligated Like Cats to Have a Clean Face”: Malaria, Quarantine, and Race in Neocolonial Cuba, 1898-1940

In a paper presented to the Academy of Medical, Physical and Natural Sciences of Havana on December 14, 1923, Dr. Jorge LeRoy y Cassá identified the “unsanitary immigration” to Cuba of Haitians and British West Indians as his country's most pressing health problem. “Those undesirable elements,” he contended, had introduced malaria, smallpox, typhoid fever, and intestinal parasites into eastern Cuba, maladies which then spread to the rest of the island. Through their “vices,” “violent crimes,” and “nefarious practices of brujerí;a [witchcraft],” in fact, Afro-Caribbean immigrants constituted a “double threat”—moral as well as physical—to the health of the Cuban nation. Somewhat surprisingly, the man who was later hailed as the “Father of Cuban Sanitary Statistics” mustered no direct evidence to support his condemnation of West Indian immigration on medical grounds. But such proof was hardly necessary for his esteemed audience. Although the medical doctors and public health officials assembled before LeRoy y Cassa at the Academy of Sciences may have differed on the issue of prohibiting.

“We Cubans Are Obligated Like Cats to Have a Clean Face”: Malaria, Quarantine, and Race in Neocolonial Cuba, 1898-1940

In a paper presented to the Academy of Medical, Physical and Natural Sciences of Havana on December 14, 1923, Dr. Jorge LeRoy y Cassá identified the “unsanitary immigration” to Cuba of Haitians and British West Indians as his country's most pressing health problem. “Those undesirable elements,” he contended, had introduced malaria, smallpox, typhoid fever, and intestinal parasites into eastern Cuba, maladies which then spread to the rest of the island. Through their “vices,” “violent crimes,” and “nefarious practices of brujerí;a [witchcraft],” in fact, Afro-Caribbean immigrants constituted a “double threat”—moral as well as physical—to the health of the Cuban nation. Somewhat surprisingly, the man who was later hailed as the “Father of Cuban Sanitary Statistics” mustered no direct evidence to support his condemnation of West Indian immigration on medical grounds. But such proof was hardly necessary for his esteemed audience. Although the medical doctors and public health officials assembled before LeRoy y Cassa at the Academy of Sciences may have differed on the issue of prohibiting.